Provider Demographics
NPI:1306889209
Name:KENNEDY, JAMES F (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2224
Mailing Address - Country:US
Mailing Address - Phone:586-772-1360
Mailing Address - Fax:586-772-9411
Practice Address - Street 1:21321 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2224
Practice Address - Country:US
Practice Address - Phone:586-772-1360
Practice Address - Fax:586-772-9411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO1767OtherBLUECROSS/BLUSHIELD
MI0E05120Medicare ID - Type Unspecified
MIT82858Medicare UPIN